ACUTE LYMPHOBLASTIC LEUKEMIA STUDY GROUP OF INDIA ALL SGI Dr - PowerPoint PPT Presentation

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ACUTE LYMPHOBLASTIC LEUKEMIA STUDY GROUP OF INDIA ALL SGI Dr

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ACUTE LYMPHOBLASTIC LEUKEMIA STUDY GROUP OF INDIA ALL SGI Dr Suresh Advani Mumbai , INDIA. ALL MAGNITUDE OF PROBLEM IN INDIA Population : 1 Billion + Pop. – PowerPoint PPT presentation

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Title: ACUTE LYMPHOBLASTIC LEUKEMIA STUDY GROUP OF INDIA ALL SGI Dr


1
ACUTE LYMPHOBLASTIC LEUKEMIA STUDY GROUP OF
INDIA ALL SGI
  • Dr Suresh Advani
  • Mumbai , INDIA.

2
ALL MAGNITUDE OF PROBLEM IN INDIA
  • Population 1 Billion
  • Pop. lt 18 yrs 40
  • New cases/ yr 8000
  • Per capita GNP US 350
  • National Priority ID Nutritional
    Diseases
  • 1 in 7 people in the world, Indian!

3
ALL IN INDIA FACTS
  • 8000 new cases/yrlt 1000 adequately Rxed
  • Mostly Morphological diagnosis
  • No National data available
  • Tough gt 70 cured in West, in India except in
    major centres results still very poor.
  • Cost of Rx 1500 affordability 70/2 5/5
  • Access to Rx PCUs infrastructure
  • Most are HR late presentation biology?
  • Females under represented

4
ALL IN INDIA - BACKGROUND
  • Before 90s Survival rate of lt 30
  • Rx not organized
  • Criteria for protocol entry not well defined
  • Diff. protocols used even in same Institution!
  • 1st effort to organize ALL Rx was by
  • Dr Ian Magrath The NCI initiative 1985
  • ACI TMH AIIMS

5
OAS 65.5
n688
6
All IN INDIA NCI INITIATIVE
  • Helped to
  • organize Rx for ALL
  • develop infrastructure
  • Rx patients uniformly- inside/outside
  • anticipate problems deal with them
  • identify some prognostic factors
  • The success with MCP 841 protocol at the National
    level has been the impetus to form the ALLSGI !

7
ALLSGI FORMATION
  • Jan 27, 2001 Pre ISMPO Hyderabad
  • Why now?
  • More trained Oncs Many trained with us
  • PCUs increasing
  • SIOP Initiative Training of Peds
  • INCTR Initiative expertise, training, res.
  • Better Communication Transport

8
ALL SGI INITIAL OBJECTIVES
  • To get organized
  • To get used to data collection
  • Identifying participating centers
  • Try to develop infrastructure at participating
    centers (Dx Nursing BBMicrobiology)
  • Chalk out short term objectives long term goals!

9
ALL SGI FORMATION OF ZONES
  • India is Big Country Many centers, Many Pts
  • North Zone AIIMS, Delhi
  • East Zone KMC, Calcutta
  • South Zone ACI,Chennai
  • West Zone TMH, Mumbai
  • Central data collection Monitoring unit

10
(No Transcript)
11
ALL SGI What Have We Achieved So Far
  • -Data of gt2000 patients treated uniformly on a
    single protocol
  • Publications from individual centres
  • Publications of data as a group

12
Event-Free Survival by Center
TMH
Percent Event Free Survival
AIIMS
CI
Years since start of therapy
13
Risk Factors (EFS) Multivariate Analysis
  • WBC at AIIMS and Mumbai (p0.0005 and 0.002
    respectively), not at CI
  • But best risk group still lt 70 EFS
  • No significant risk factors could be identified
    at Chennai nor in Pre B or Pre-T separately
  • No very high or very low risk groups identifiable
    at all three centers
  • Early response not studied

Extensive analysis performed by experienced NCI
statisticians
14
Temporal Changes with Identical Protocol
1995-96
1989-90
Percent Event Free Survival
1991-92, 93-94
1986-87
TMH 2 yr intervals 101-163 patients per group
Years since start of therapy
A 1986-87 B 1988-90 C 1991-92 D 1993-94
E 1995-96 F 1997
15
Translocations in ALL
Childhood , USA
16
ALL SGI TO WRITE GRANTS
  • Grant from Lady Ratan Tata Trust For Developing
    the Cooperative Group
  • To Write Grants For
  • Epidemological studies Clinical Molecular
  • Clinical studies
  • Lab studies Pathogenesis, Mol. Biology
  • Preventive Aspects

17
ALL SGI ALL TREATMENT
  • Develop infrastructure
  • Rx data initially only from limited centers
  • To continue established protocol (e.g. MCP 841)
    at these centers
  • Investigational protocol(e.g. MCP 943) only at
    zonal centers
  • Highest quality of information must be assured
    Diag, data collection, data analysis
  • Once group established, only then to think about
    ALL National Protocol- keeping in mind simplicity
    cost!

18
ALL SGI LONG TERM GOALS RESEARCH INITIATIVES
  • Is ALL in India Biologically different?
  • Std risk factors do not show diff in outcome
  • many remission deaths
  • Delays in Rx hepatitis, toxicity,etc
  • Socioeconomic risk profile
  • Toxicity profile
  • Nutritional status
  • Pharmacokinetics, Pharmacogenomics
  • Difference in Leukemic cell or Patient ??

19
ALL FUTURE PLANS
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